| NPI | 1417212556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 278003) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 64231-20) |
| 208D00000X General Practice (Licence: IL 125.060774) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2022-09-26 |